Please fill out the form below and be as honest and detailed as possible! I am excited to get started with you.

If you are a returning client, it is enough to answer the questions with a *.

Name *

Name

First Name

Last Name

Email *

Phone *

Phone

Country

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Mailing Address *

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthday

Did someone refer you to me?

If so, please tell me their name so I can thank them for connecting us.

What motivated you to sign up for this program? *

What is the most significant missing piece in your life? *

What makes you say that?

What negative emotions would you like to move away from? *

What causes you the most stress and worry? *

What makes you say that?

What is your greatest fear?

What makes it scary?

If you died today, what would you regret not having experienced in your life?

What do you definitely want to experience in your life?

E.g. have a baby, move to a new country, publish a book, find your soulmate..

What were the major defining moments in your life?

These are events that changed everything for you, or after which 'nothing was the same'. List some that were negative as well as some that were positive.

What areas of your life are already going well?

What are your talents and strengths?

What are you proud of about yourself?

What do you most love to do?

Look for what you love to do and what you can do for long stretches of time without getting tired or bored.

I am at my very best when I am...

How do you most often help others?

What do people thank you for that you enjoy doing?

What are the three most important relationships in your life?

Please list them in order of importance.

What do you have to have in your life, so that you can feel at ease and fully be you?

E.g. be around people who know you well, meditate daily, at least 90% plant based food, weekly hikes..
Think about the non-negotiables when it comes to your daily wellbeing!

If you had unlimited time and resources, what would you do with your life?

What would you pursue if success was guaranteed?

Where and how would you like to live?

What would you like to own?

Houses, business equipment, cars, furniture, clothes...

Who would you like to spend most of your time with?

What places would you like to see?

What roles models would you like to meet?

What would you like to learn?

What would you like to be a master of?

How much money would you like to make?

What adventures would you like to take?

Who would you like to become?

How would you like to feel in your everyday life?

How would you like to feel in your body?

What would you like to be seen as?

What would you like to be known for?

What are the three outcomes you are most excited to get out the program? *

E.g. clear business mission, fearless confidence...
Please list the outcomes in order of importance.

Lastly, one of the things I really believe in is in rewarding my clients for sending referrals and because of that, my business is mostly referral-based. Would you please let me know what 5 or 6 things you would want to receive from me as a thank you for a referral? (Bottle of wine, a specific book, magazine subscription, movie tickets, etc.) *

Is there anything else you would you like me to know before we get started?